Necessity of Bilateral Chest Tube Insertion, after Transhiatal Esophagectomy in Esophageal Cancer

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ntroduction: Esophageal dysfunction occurs due to various disorders such as benign or malignant tumors, perforations, and motility disorders. Esophagectomy is considered as the final option for treatment of the diseases. Except malignant cases, in which lymphatic dissection is considered, transhiatal esophagectomy is the appropriate procedure for the esophageal cancer. Avoidance of thoracotomy and thoracic anastomosis are of advantages which reduces morbidity and mortality rate in transhiatal esophagectomy. In the procedure, pleural drainage through bilateral tube thoracostomy is routinely recommended. The aim of the study was to evaluate application of routine thoracostomy and to find specific criteria concerning chest tube insertion.
 
Materials and Methods: This descriptive study was performed from 2001 to 2005 in General Surgery Department of Imam Reza hospital. Participants included 123 patients who underwent transhiatal esophagectomy. Blood sampling, Chest radiography, abdominal ultrasonography, barium swallow, cardiopulmonary function tests, and upper GI endoscopy was carried out for all patients. Individual, radiography and laboratory findings, post operation complications and mortality were collected in a questionnaire and analyzed by the descriptive statistics and frequency distribution tables.
 
Results:Patients, 84 male (68.3%) and 39 female (31.7%), with mean age of 57.7 years underwent transhiatal esophagectomy. Clinical diagnosis of 94% of cases was squamous cell carcinoma (S.C.C.). Surgical complications included rupture of azygous vein in 1 case, chylothorax in 2 cases, right main bronchial injury in 1 case, anastomosis fistula in 2 cases, and wound infection in 4 cases. Chest tube insertion was performed in 41 cases (33.3%) at the end of operation, and in 19 cases (15.4%) postoperatively. Volume drainage > 400cc was reported in 29% of patients and tube duration > 4 days in 51% of patients.
 
Conclusion:Transhiatal esophagectomy which was inaugurated in 1933 is a less morbid procedure among various approaches of esophagectomy. Bilateral chest tube insertion can cause less movement of the patient and respiratory distress, and rise surgical complications including thromboemboli, empyema, atelectasis, and lung infection. According to the results of this study, tube thoracostomy is indicated for following reasons: a. high volume of intraoperative mediastinal bleeding, b. pleural effusion irrelevant to the operation, c. postoperative respiratory distress along with pleural effusion, and d. asymptomatic high volume of pleural fluid.